Card Set Information
Second Test material
What is the first intervension for someone who has UC dysfunction?
Could be cramping due to dehydration.
Can also ambulate, distract, rest, etc.
Rx is last resort.
What are some causes of maternal dystocia?
Any other fleshy obstruction to the vaginal canal.
What are some causes of fetal dystocia?
Multiple feti (twins, trips, God forbid quads)
What is always the biggest risk for malpositioned/breeched presentations?
Get baby out quickly! May mean shoving head back in and running to OR.
What do you do about shoulder dystocia?
Drop bed to Trundelburg's
place Mom in McBob's postion
: knees bent and shoved way up towards chest. Hopefully this will roll pelvis bone over shoulder.
Can also apply suprapubic pressure to rotate shoulder medially to tuck it under the pupic bone.
May also break collar bone to deliver. Will reset very quickly after birth but will leave a lump in the bone.
What is the major symptom of placenta previa?
Painless vaginal bleeding, usually ~34ks.
may also present with contractions.
NEVER do a SVE on pt with previa and/or vaginal bleeding!!!
Which tocolytic do you want to administer before attempting a version?
What is an amniotomy and why would you consider doing one?
Artificial rupture of fetal membrane (SOW)
To induce labor
apply an internal FSE
Obtain a fetal scalp blood sample
Why would you consider an amnioinfusion?
Prevent variable decels
Treat variable deels
*Will not be effective if goal is to dilute meconium stained amniotic fluid.
What are some maternal and fetal indications for foreceps delivery?
Acute pulomanary edema
prolonged 2nd stage
Exhaustion (mom simply is incapable of more pushing.
premature placental separation (abruptio placentae!)
Non-reassuring fetal status)
What are the primary considerations when caring for a patient post c/s?
: H2 receptor antagonist. Inhibits gastric secretions. Used prophylactically to prevent stomach content aspiration during c/s.
: Dopamine antagonist. Antiemetic used during c/s and prophylactically for postop.
: Reduces stomach pH.
What are the indications for a VBAC?
One previous c/s birht and low transverse uterine incision
no other uterine scars or pervious uterine rupture
avaliable dr who can do c/s
in-house anesthesia personnel.
What are some factors leading to uterine atony?
1st line pph.
Must dilute in 1000mL LR
Prolonged admin-->antidiuretic and water toxicity
CX for HTN
Do not admin IV to v risk of sudden HTN
Cx for cardiac, renal, or pulmonary dysfnxn.
Do not admin IV
Few side effects
Most commonly admin'd PR (rectal)
Either vaginal or rectal admin
What are some indications for locations of pp hematoma?
Typically present with peri pain
Rectal pressure if in posterior vaginal area
Diff urinating if in upper part of vagina
Pelvic pain if subperitoneal hematoma
All may-->shock if unidentified
What are some causes of uterine rupture?
Tachysystole or hypertonus
What are the SnSs of uterine rupture?
Severe abd pain
Changing uterine tone
fetal station may suddenly change
Referred pain (possibly to shoulder)
maternal tachycardia and hypotension
palpation of fetus through abd wall.
What are the biggest risk factors for developing abnormal placental adherence?
What are the two main causes of late pph
--fundus remains high
--lochia fails to progress from rubra to serosa to alba
--usually because of retained placenta
--Tx with Methergine ~1wk.
Retained placental fragment
--D & C (debridement and curatage).
What are some early signs of alcohal withdrawl in the neonate?
Hyperactive w/ little interest in environment
What are some maternal risks for crack/cocaine use during pregnancy?
spontaneous abortion, abruptio placentae (biggest) IUGR, pretuern birth, stillbirth
What are some fetal risks for maternal crack/cocaine use during pregnancy?
v birth weight and head circumference
if in breast milk
What is the biggest concern with pregenstational type I DM?
What is the effect of HPL on maternal insuline needs during pregnancy?
HPL-->v insulin sensitivity in mom, so-->^ demand of insulin supply to x2-x4 pregrenancy needs.
What is the screening method for determining GDM?
screen at 24-28 weeks, earlier if high risk
50gm glucose test
--draw blood in 1hr during which no eating, exercise, or smoking
>135-->risk for GDM
What is the diagnostic test for diagnosing GDM?
3 hr GTT with 2/4 results elevated
Done via overnight fast followed by 100gm glucose drink.
Draw blood at 0,1, 2, and 3 hr.
What are the risks associated with GDM?
x2 risk preeclempsia
RDS from delayed pulmonary maturation
hypoglycemai within 1hr birth
What are additional concerns if pregestational diabetes?
congenital heart anomolies
pernatal loss, anomalies, and sudden unexplained stillbirth
What are some good pregestational DM teaching points?
establish good control before attempting conception because...
--x5 risk of heart and CNS anomolies
Help mom anticipate normal elevated insulin demands during pregnancy
HgbA1c is good indication of control
Nutrition, rational, and home monitoring
Suppliment with insulin if not entirely diet controlled
Monitor fetus with NST and ultrasound
PG more reliable than L:S ratio for determining fetal lung maturity
Why is breastfeeding encouraged after delivery of the diabetic mother?
has an antidiabetic effect
lowers insulin needs to 1/2 of prepregnancy levels
v baby's risk of becoming diabetic
What is criteria for diagnosing chronic HTN in pregnant mom?
Present before pregnancy or up to 20 weeks gestation
^risk of developing pre/eclampsia
Risks of chronic HTN during pregnancy
pulmonary edema after delivery
What should women with chronic HTN take if they want to breastfeed?
T/F women with HIV can breastfeed without risk to neonate.
Virus passes in breastmilk
What increases risk of passing HIV to birthing child?
^ viral load
**always test neonate at least 6mo after birth. Will always test positive before 6mo.
What are some maternal risks associated with HIV?
v wound healing
nfxn of genitourinary tract
Neonate risks associated with HIV?
v birth weight
what can you do for the neonate of an HIV pos mom?
antiretrovirals first 6wks
routine vaccines, but no OPV, MMR, or Varicella because they are live viruses.
No family members should get these either.
What are complications of PKU?
Toxic build up of phenylalanine
teratogenic-->microcephaly, mental retardation, cardiac defects
Mom must be on strick diet BEFORE and THROUGHOUT conception. Not much use to start diet afterward.
Subtle neuro, behavioral, and IQ effects if diet discontinued after age 6.